Eating disorders are serious mental health conditions that affect eating behaviour, thoughts about food and, in many cases, feelings about weight or body shape. They can also cause dangerous physical complications—even when someone does not look noticeably underweight.
An eating disorder may involve restricting food, binge eating, vomiting, misusing laxatives, exercising compulsively or avoiding foods because of their texture or a fear of choking. Some people experience several of these patterns rather than fitting neatly into one diagnosis.
Eating disorders can affect people of any age, gender, ethnicity, weight or background. They are not a choice, a phase or simply an attempt to look different. With appropriate treatment and support, recovery is possible.
This article provides general information and does not replace medical advice. Call 999 if someone has collapsed, is seriously unwell or is in immediate danger.
What is an eating disorder?
An eating disorder is a mental health condition in which eating behaviours become closely tied to difficult thoughts, emotions, fears or attempts to cope. The person may feel compelled to follow strict rules, avoid food, binge, compensate for eating or repeatedly check their body.
The behaviour can provide a temporary sense of control or relief. Over time, however, the rules and rituals often become more demanding. Food may occupy much of the day, social situations become harder and physical health begins to suffer.
Someone does not have to meet every feature of a particular diagnosis to need help. Eating disorders exist across a wide range of body sizes, and the seriousness of the illness cannot be judged from appearance alone.
It is also possible for a person to move between different patterns. Someone may restrict food for a period, later experience binge eating and then begin compensating through vomiting or excessive exercise.
The NHS overview of eating disorders provides further information about symptoms, diagnosis and treatment.
Different types of eating disorder
Anorexia nervosa
Anorexia involves restricting food or using other behaviours to keep body weight significantly lower than is healthy. A person may have an intense fear of gaining weight, place great importance on shape or weight, or struggle to recognise how medically serious the illness has become.
Restriction may be combined with excessive exercise, vomiting or misuse of laxatives or diuretics. Some people eat a wide range of foods but in very small quantities, while others gradually remove more and more foods from their diet.
People with symptoms similar to anorexia can be seriously unwell without being underweight. This is sometimes described as atypical anorexia and may be diagnosed within the broader category of OSFED.
Bulimia nervosa
Bulimia involves repeated episodes of binge eating followed by attempts to compensate for the food eaten. During a binge, someone feels unable to stop or control how much they are eating.
Compensatory behaviour may include vomiting, fasting, excessive exercise or misusing laxatives or diuretics. The cycle is commonly accompanied by shame, secrecy and strong concerns about weight or body shape.
A person with bulimia may remain at a weight that appears typical, so the condition can be hidden for a long time.
Binge eating disorder
Binge eating disorder involves regularly eating a large amount of food in a relatively short period while feeling unable to stop. The person may eat quickly, continue when uncomfortably full or eat in secret because of embarrassment.
Unlike bulimia, binges are not regularly followed by vomiting or other compensatory behaviours. Afterwards, the person may feel guilt, sadness, disgust or hopelessness.
Binge eating disorder is not the same as occasionally overeating. It involves a recurring loss of control and significant emotional distress.
Other specified feeding or eating disorder
Other specified feeding or eating disorder, or OSFED, is diagnosed when someone has a clinically significant eating disorder that does not meet every criterion for anorexia, bulimia or binge eating disorder.
OSFED is not a mild or less important condition. It can produce severe psychological distress and dangerous physical consequences. According to the NHS, it is the most common eating-disorder diagnosis.
Avoidant/restrictive food intake disorder
Avoidant/restrictive food intake disorder, known as ARFID, involves avoiding foods, limiting the amount eaten or both. Unlike anorexia and bulimia, the restriction is not driven by a desire to lose weight or change body shape.
A person with ARFID may have:
- intense sensitivity to the taste, texture, smell or appearance of food;
- little interest in eating or a limited awareness of hunger;
- fear of choking, vomiting or having an allergic reaction;
- a very small range of foods they feel able to eat.
ARFID can lead to nutritional deficiencies, weight loss, delayed growth or dependence on supplements. It is more than ordinary fussy eating and may affect children or adults.
Signs that you may have an eating disorder
It can be difficult to recognise an eating disorder in yourself. Behaviours often develop gradually and may initially feel like sensible attempts to eat more healthily, improve fitness or gain control.
Possible signs include:
- spending a large part of the day thinking about food, calories, weight or body shape;
- feeling frightened, guilty or ashamed after eating;
- missing meals or eating very little;
- creating increasingly strict food rules;
- removing whole food groups without a medical reason;
- regularly eating until uncomfortably full and feeling unable to stop;
- making yourself sick after eating;
- using laxatives, diuretics or appetite suppressants to influence weight;
- exercising despite illness, injury or exhaustion;
- repeatedly weighing yourself or checking your body;
- avoiding meals with other people;
- hiding, storing or secretly disposing of food;
- feeling that your mood or self-worth depends on what you have eaten or what you weigh.
You may tell yourself that you are “not ill enough” because someone else eats less, weighs less or has received hospital treatment. This comparison is part of what can delay help. You deserve an assessment whenever eating behaviour is causing distress or affecting your life.
Exercise can become part of the disorder
Exercise may be compulsive when it feels impossible to rest, is used to compensate for eating or continues despite injury and exhaustion. The person may become highly distressed when a workout is missed or feel they have to earn food through physical activity.
The amount of exercise alone does not determine whether it is a problem. Its purpose, rigidity and effect on physical and emotional health are important.
Eating disorders are not always about appearance
Body-image concerns are central to many eating disorders, but not all. ARFID may involve sensory sensitivities or fear of choking, while some people restrict food as a way of managing emotions, self-punishment or a need for control.
A person may also struggle to identify or explain what drives the behaviour. Help does not depend on already understanding the cause.
Signs of an eating disorder in someone else
Eating disorders are often hidden. Someone may avoid meals, give plausible explanations for weight changes or insist that they have already eaten. Behavioural and emotional changes can therefore be as important as appearance.
Possible warning signs include:
- avoiding family meals or situations involving food;
- becoming secretive about eating;
- frequently going to the bathroom during or soon after meals;
- wearing loose clothing to hide changes in body shape;
- eating unusually slowly, cutting food into tiny pieces or following rigid rituals;
- buying or hiding large amounts of food;
- food repeatedly disappearing from cupboards;
- exercising excessively or becoming distressed when unable to exercise;
- withdrawing from friends and previously enjoyed activities;
- increasing irritability, anxiety, low mood or perfectionism;
- frequent comments about feeling fat, guilty or undeserving of food;
- marked weight change or failure to grow as expected.
Some people do not show an obvious change in weight. Bulimia, binge eating disorder, ARFID and OSFED can all occur in bodies that do not match common stereotypes of an eating disorder.
In children and teenagers, look for changes in growth as well as weight loss. A child who fails to gain weight or height as expected may be medically affected even if they have not visibly lost weight.
Physical effects and urgent warning signs
Restricting food, bingeing, vomiting and misusing laxatives or diuretics can affect nearly every body system. Possible physical signs include:
- feeling unusually cold, weak or tired;
- dizziness, faintness or fainting;
- a racing, very slow or irregular heartbeat;
- bloating, abdominal pain, constipation or diarrhoea;
- dehydration and muscle cramps;
- poor concentration or confusion;
- dry skin, fragile nails or hair loss;
- swelling around the cheeks or jaw;
- dental erosion, mouth ulcers or a sore throat from vomiting;
- periods becoming irregular or stopping;
- reduced sex drive or changes in sexual function;
- delayed puberty or growth in younger people;
- frequent injuries or stress fractures.
These complications can occur at different body weights. A person who has lost weight rapidly may be medically unstable even when their BMI does not appear particularly low.
When to call 999
Call 999 if someone with a suspected or diagnosed eating disorder:
- has collapsed or cannot be woken normally;
- has severe chest pain or serious breathing difficulty;
- has a seizure;
- is severely confused or extremely weak;
- is vomiting a significant amount of blood;
- has taken an overdose;
- is in immediate danger of suicide or serious self-harm.
When to seek urgent same-day advice
Contact a GP urgently or use NHS 111 if the person is repeatedly fainting, unable to keep fluids down, showing signs of significant dehydration, experiencing palpitations or deteriorating rapidly.
NICE recommends acute medical care when an eating disorder has caused severe malnutrition, dehydration, electrolyte disturbance or signs that organs may be affected. Decisions about hospital care should not be made using one BMI or weight threshold alone.
What causes eating disorders?
There is no single cause and no one is to blame. Eating disorders usually develop through a combination of biological, psychological and social factors.
Possible contributing factors include:
- a family history of eating disorders or other mental health conditions;
- anxiety, depression, OCD or low self-esteem;
- perfectionism or a strong need for control;
- autism, ADHD or sensory sensitivities;
- bullying or criticism about weight, shape or eating;
- trauma, abuse, bereavement or major life changes;
- dieting or repeated attempts to lose weight;
- pressure associated with sport, dance, modelling or weight-based competition;
- social messages that attach moral value to thinness, fitness or particular foods.
Not everyone exposed to these factors develops an eating disorder. Sometimes there is no obvious trigger.
Dieting may begin for health, sport or appearance reasons but can become increasingly rigid. Restriction also has biological effects: inadequate nutrition can intensify preoccupation with food, anxiety, irritability and inflexible thinking. This can make it harder to reverse the behaviour without support.
Eating disorders may coexist with anxiety disorders, depression or obsessive-compulsive symptoms. Each problem should be properly assessed rather than assuming that treating one will automatically resolve everything.
How are eating disorders diagnosed?
If you are concerned about your eating, arrange an appointment with a GP. You can ask to see a different clinician if you would feel more comfortable discussing the subject with them.
The GP may ask about:
- what and how regularly you eat;
- binge eating, vomiting, laxatives or other compensatory behaviours;
- thoughts about weight, body shape and food;
- exercise and whether it feels compulsory;
- recent changes in weight, growth or menstrual periods;
- physical symptoms such as fainting, palpitations or digestive problems;
- mood, anxiety, self-harm and suicidal thoughts;
- how eating affects work, education, relationships and social life.
You may be weighed, but weight should only be one part of the assessment. The GP may check pulse, blood pressure and temperature and arrange blood tests or an ECG to assess physical safety.
Blood tests may look for dehydration, electrolyte problems, anaemia and changes in liver, kidney or thyroid function. Normal test results do not mean there is no eating disorder. They provide a snapshot of certain aspects of physical health and can remain normal until an illness is advanced.
Our guide to understanding blood test results explains why results must be interpreted alongside symptoms and clinical history.
Referral to a specialist service
If the GP suspects an eating disorder, they may refer you to a specialist eating-disorder team. These teams can include psychiatrists, psychologists, therapists, dietitians, nurses, paediatricians and other medical specialists.
Referral decisions should consider eating behaviour, rate of weight change, physical health and psychological risk—not just whether someone is below a particular weight.
Be honest about behaviours such as vomiting or laxative use. Clinicians ask because these can disturb salts in the blood and affect the heart, not because they are judging you.
What treatment is available?
Treatment depends on the diagnosis, age, physical health and individual circumstances. Most people are treated through outpatient appointments, although day-patient or inpatient care may be needed when physical or psychological risk is high.
Treatment usually combines specialist psychological therapy with nutritional rehabilitation and physical monitoring. Recovery involves more than changing weight: therapy also addresses the thoughts, emotions and behaviours that maintain the disorder.
Treatment for anorexia
Adults with anorexia may be offered eating-disorder-focused cognitive behavioural therapy, Maudsley Anorexia Nervosa Treatment for Adults or specialist supportive clinical management. These approaches differ, but generally support nutritional recovery while addressing fear, rigid rules and the wider effects of the illness.
For children and teenagers, family-based treatment is commonly central. Parents or carers are supported to help the young person eat adequately and gradually return control as recovery develops. Involving a family does not mean that the family caused the illness.
Treatment for bulimia
Treatment may begin with guided self-help specifically designed for bulimia. If this is not suitable or does not help enough, eating-disorder-focused CBT may be offered.
Therapy works on establishing regular eating, understanding triggers for bingeing and reducing vomiting, fasting or other compensatory behaviours.
Treatment for binge eating disorder
Guided self-help or group eating-disorder-focused CBT is commonly offered first. Individual CBT may be considered when group treatment is unsuitable or has not been effective.
Treatment focuses on regular eating and the emotional and behavioural cycle behind binges. Weight loss is not normally the immediate aim of binge eating disorder therapy, and dieting during treatment can make binge eating more difficult to change.
Treatment for ARFID and OSFED
OSFED treatment is usually based on the eating-disorder pattern the symptoms most closely resemble. ARFID treatment may address sensory sensitivities, fear-based avoidance, limited interest in food, nutritional deficiencies and the gradual expansion of safe foods.
Children with ARFID may need support from paediatrics, dietetics, psychology, occupational therapy or speech and language therapy, depending on the reason for restriction.
Medication
Medication is not the sole treatment for anorexia, bulimia or binge eating disorder. It may sometimes be used alongside therapy, particularly when depression, anxiety or obsessive-compulsive symptoms are also present.
Any medicine must be considered carefully when someone is dehydrated, undernourished or has disturbed electrolyte levels, as these problems can affect how safely medicines are used.
Nutritional rehabilitation
Restoring regular, adequate nutrition is an important part of treatment. When someone has been severely restricting food, increasing intake may need clinical supervision because rapid changes can occasionally cause a dangerous shift in fluids and electrolytes known as refeeding syndrome.
This is not a reason to delay seeking help or continue restricting. It is a reason to involve a healthcare professional rather than trying to manage severe malnutrition alone.
How to get help in the UK
A GP is usually the first point of contact. You do not need to be certain that you have an eating disorder before making an appointment.
You could say:
“I am worried that my eating and thoughts about food are becoming difficult to control. It is affecting my physical health and daily life, and I would like an eating-disorder assessment.”
If weighing is distressing, tell the clinician. You can ask not to be told the number, although they may still need to measure it for medical assessment. You can also take a friend, relative or written list of symptoms to the appointment.
If you feel that your concerns were dismissed because of your weight, gender or appearance, arrange another appointment and explain which behaviours and physical symptoms are worrying you. You can ask what follow-up is planned and when specialist referral should be considered.
Our guide to accessing mental health services in the UK explains the main NHS routes. If getting an appointment is difficult, see our guide to getting a GP appointment.
Charity and peer support
Beat provides UK information, helpline support and a HelpFinder service for people with eating disorders and those supporting them. Beat is not an emergency medical service; use NHS 111, 999 or local crisis services when someone is medically or psychologically unsafe.
For readers in the United States, the National Alliance for Eating Disorders provides support and referrals on 1-866-662-1235.
How to support someone with an eating disorder
Choose a private, calm time to speak. Focus on specific changes you have noticed rather than appearance or weight.
You might say:
“I’ve noticed that meals seem very stressful and that you have been avoiding things you usually enjoy. I’m worried about how you’re feeling. Can I help you speak to someone?”
Try to listen rather than debate whether the person is thin, eating enough or “really” unwell. Reassuring them that they look healthy can accidentally feel like confirmation that they do not deserve help—or, in some disorders, that they need to intensify the behaviour.
Avoid:
- commenting on weight gain or loss;
- praising restrictive eating or compulsive exercise;
- turning meals into arguments about willpower;
- threatening or shaming the person;
- discussing diets, calories or your own weight around them;
- promising to keep dangerous symptoms secret.
You can offer to arrange an appointment, travel with them or help write down symptoms. If the person is a child, medically unwell or at immediate risk, adults may need to seek professional help even when the person does not want them to.
Supporting someone through an eating disorder can be demanding. Carers deserve information and emotional support of their own and may be included in treatment when appropriate.
Recovery from an eating disorder
Recovery is possible, but it is rarely a perfectly straight path. Progress may include eating more regularly, reducing dangerous behaviours, improving physical health and becoming less controlled by thoughts about food or weight.
Some people notice that anxiety initially increases when they begin changing eating-disorder behaviours. This does not mean treatment is failing. The behaviours may have been serving as a coping mechanism, and learning safer ways to manage emotions takes time.
Relapses and difficult periods can happen, particularly during stress or major changes. Recognising early warning signs and returning to the treatment plan promptly can prevent a temporary setback from becoming a full recurrence.
Recovery does not require a person to love every aspect of their body or never have another difficult thought. It means developing enough flexibility and support for food and body concerns no longer to control everyday life.
Frequently asked questions about eating disorders
Can you have an eating disorder at a healthy or higher weight?
Yes. Bulimia, binge eating disorder, ARFID, OSFED and atypical anorexia can occur at any body size. A person can be medically and psychologically unwell without appearing underweight.
Do eating disorders only affect teenage girls?
No. They affect children, adults and older people of all genders. Boys and men may be overlooked, particularly when symptoms focus on muscularity, exercise or “clean eating” rather than thinness.
Is an eating disorder a choice?
No. Behaviours may initially feel voluntary, but eating disorders are serious mental health conditions. Shame and blame make it harder to ask for help.
What is the difference between overeating and binge eating?
A binge involves a sense of losing control, usually while eating a large amount in a relatively short period, and is followed by significant distress. Occasionally eating more than intended—for example, during a celebration—is not by itself binge eating disorder.
Do laxatives prevent weight gain from food?
Laxatives mainly affect the large bowel after most nutrients have already been absorbed. Misuse does not reliably prevent calorie absorption and can cause dehydration, electrolyte disturbance and bowel problems.
Can healthy eating become an eating disorder?
An interest in nutrition becomes concerning when rules grow rigid, foods are increasingly feared, breaking a rule causes intense guilt or the behaviour harms physical health and social life. The label “healthy” does not make severe restriction safe.
Can someone recover without gaining weight?
The needs differ between individuals. Someone who is undernourished or whose growth has been affected may need weight restoration as part of physical recovery. People at other weights may need to change dangerous behaviours and restore adequate nutrition without treatment focusing primarily on a particular number.
Will a GP make me stand on the scales?
Weight may be medically important, but you can explain that seeing the number is distressing and ask to be weighed facing away from the display. The assessment should also consider behaviour, physical observations, rate of change and psychological symptoms.
Can I self-refer to an eating-disorder service?
This depends on the local service. Some accept self-referrals, while others require a GP or another clinician to refer you. NHS Talking Therapies self-referral is not normally the main route for specialist eating-disorder treatment.
When is hospital treatment needed?
Most people receive outpatient care. Day-patient or inpatient treatment may be needed when physical health is severely compromised, symptoms are worsening quickly, outpatient treatment cannot keep the person safe or there is a serious risk of self-harm.
What should I do if someone refuses help?
Stay calm, continue expressing concern and offer practical support with arranging an assessment. If the person is a child, is medically deteriorating or may be in immediate danger, contact a GP, NHS 111 or emergency services even if they object.
